We are NOT authorized by Govt of India for Yellow Fever Vaccination

Friday, February 24, 2017

The most recent update on the yellow fever outbreak in Brazil reveals additional confirmed cases and deaths since the last update a few days ago. According to the Brazil Ministry of Health, or Ministério da Saúde, as of Feb. 20, 1,286 suspected cases of yellow fever were reported to the Ministry of Health, of which 274 were confirmed.

Image/CDC

To date, 92 confirmed yellow fever deaths have been reported, with the case fatality rate among confirmed cases stands at 33.6%.

Of the confirmed cases, 235 have been reported in Minas Gerais state, or 86 percent of the total cases. Seventy-nine of the confirmed fatalities occurred in the state.

As of Feb. 20, 2017, 883 epizootic diseases were reported to the Ministry of Health in non-human primates (PNH), of which 212 remain under investigation, 8 were discarded and 377 were confirmed for yellow fever.

Friday, February 17, 2017

Caribbean Airlines (CAL) is advising all citizens with intentions of travelling to Suriname to ensure they have had their yellow fever vaccine and documentation to support it.

In a press release, the national carrier said, "Caribbean Airlines has been advised that the Ministry of Health, Suriname will be conducting intensified checks on yellow fever immunization for travelers from yellow fever risk regions. These regions include but are not limited to: Trinidad and Tobago, Guyana and Venezuela."

Head of Corporate Communications, Dionne Ligoure stated: “To ensure an uninterrupted travel experience, Caribbean Airlines is recommending that all persons intending to travel, make certain that their vaccinations are up to date. Persons are advised to carry their International Immunization Card with proof of valid Yellow Fever and other vaccinations when travelling to Suriname.”

Customers are responsible for meeting all documentation and proof of citizenship requirements for travel. Failure to comply with these Ministry of Health requirements could result in inconvenience and additional expenses to be borne by the traveller.

Summary-------BackgroundOutbreaks of unexplained illness frequently remain under-investigated. In India, outbreaks of an acute neurological illness with high mortality among children occur annually in Muzaffarpur [Bihar], the country's largest litchi [lychee] cultivation region. In 2014, we aimed to investigate the cause and risk factors for this illness.

MethodsIn this hospital-based surveillance and nested age-matched case-control study, we did laboratory investigations to assess potential infectious and non-infectious causes of this acute neurological illness. Cases were children aged 15 years or younger who were admitted to 2 hospitals in Muzaffarpur with new-onset seizures or altered sensorium. Age-matched controls were residents of Muzaffarpur who were admitted to the same 2 hospitals for a non-neurologic illness within 7 days of the date of admission of the case. Clinical specimens (blood, cerebrospinal fluid, and urine) and environmental specimens (litchis) were tested for evidence of infectious pathogens, pesticides, toxic metals, and other non-infectious causes, including presence of hypoglycin A or methylenecyclopropylglycine (MCPG), naturally-occurring fruit-based toxins that cause hypoglycaemia and metabolic derangement. Matched and unmatched (controlling for age) bivariate analyses were done and risk factors for illness were expressed as matched odds ratios and odds ratios (unmatched analyses).

InterpretationOur investigation suggests an outbreak of acute encephalopathy in Muzaffarpur associated with both hypoglycin A and MCPG toxicity. To prevent illness and reduce mortality in the region, we recommended minimising litchi consumption, ensuring receipt of an evening meal and implementing rapid glucose correction for suspected illness. A comprehensive investigative approach in Muzaffarpur led to timely public health recommendations, underscoring the importance of using systematic methods in other unexplained illness outbreaks.

[The etiologies of seasonal encephalitis (or encephalopathies) in northeastern India have not been well defined. Many have been attributed to Japanese encephalitis (JE). However, JE virus infections have been excluded in many cases, with the undiagnosed cases termed acute encephalitis syndrome (AES). Previous ProMED-mail posts have implicated Reye syndrome, consumption of lychees, and heat stroke, as well as JE virus infections, as responsible for AES (see ProMED-mail archive no. 20161111.4621162).

Dr Jacob John has asserted that many of these are hypoglycemic Reye syndrome cases. He noted that in the pre-monsoon period, particularly in May and June, outbreaks of Reye-like acute hypoglycemic encephalopathy occur in the north western region of Bihar state and that is also popularly, but unfortunately, called AES. Many doctors, the media, and the public consider these encephalopathy cases as encephalitis because of the term AES. This has been now clarified and in June 2014 children were treated by 10 per cent dextrose infusion and many lives were saved. Other etiologies have been proposed by clinicians. A published article in a pediatric journal proposed that some cases are due to heat stroke.

It has been proposed previously that consumption of lychees is responsible for some encephalitis cases. Encephalopathy and hypoglycemia have been associated with consumption of lychee fruit containing phytotoxins, specifically alpha-(methylenecyclopropyl)glycine (see ProMED-mail archive no. 20150201.3132842). Several reports have associated AES with contaminated water, suggesting enterovirus etiology. A recent report indicates that the scrub typhus bacterium may be causing many encephalitis deaths in the nearby northeastern state of Assam.

The report above makes a convincing case for lychee consumption as the etiology of many of these cases in areas of lychee production in Bihar state. Public education will be essential to prevent these lychee intoxications. Japanese encephalitis virus is also endemic in this area, but is preventable by vaccination and should not be ignored.

Query : Good morning dr. Please my 9 months old baby took yellow fever and measles vaccines together yesterday and woke up this morning feeling so weak and he has been vomiting. Please what will i do. I gave him paracetamol that yesterday.Ans:

Friday, February 3, 2017

SAO PAULO – Authorities in Brazil's Sao Paulo state say three more people have died from yellow fever, adding to an outbreak that has seen more than 100 cases.

The vast majority of cases are in the southeastern state of Minas Gerais, where authorities had confirmed 97 cases as of Friday. Of those, 40 died.

The Health Department of Sao Paulo on Monday said it has now confirmed six cases of the disease, four of whom became infected in Minas Gerais. All of the patients died. The state of Espirito Santo has also recorded one case.

Much of Brazil is considered at risk for yellow fever, but the country has not seen this large an outbreak since 2000. The World Health Organization has said it expects the mosquito-borne to spread to more states.

Wednesday, February 1, 2017

What is the current situation?

The Brazilian Ministry of Health has reported an ongoing outbreak of yellow fever starting in December 2016. The first cases were reported in the state of Minas Gerais, but cases have since been reported in the neighboring states of Espirito Santo and Sao Paulo. Cases have occurred mainly in rural areas, with most cases being reported from Minas Gerais state. Some cases have resulted in death. Health authorities in the affected states, with assistance from the Brazilian Ministry of Health, are conducting mass vaccination campaigns among unvaccinated residents of affected areas.

In response to this outbreak, health authorities have recently expanded the list of areas in which yellow fever vaccination is recommended for travelers. For a list of these municipalities and a map showing the existing and new yellow fever risk areas in Brazil, see the World Health Organization’s most recent update (scroll down on linked page for the list).

Anyone 9 months or older who travels to these areas should be vaccinated against yellow fever. People who have never been vaccinated against yellow fever should not travel to areas with ongoing outbreaks. CDC no longer recommends booster doses of yellow fever vaccine for most travelers. However, a booster dose may be given to travelers who received their last dose of yellow fever vaccine at least 10 years ago and who will be in a higher-risk setting, including areas with ongoing outbreaks. Because of the ongoing outbreak, travelers to the Brazilian states of Minas Gerais, Espirito Santo, and parts of Bahia, Sao Paulo, and Rio de Janeiro states may consider getting a booster if their last yellow fever vaccination was more than 10 years ago. Travelers should consult with a yellow fever vaccine provider to determine if they should be vaccinated. For more information on booster shots, see “Clinician Information,” below.

What is yellow fever?

Yellow fever is a disease caused by a virus spread by mosquito bites. Symptoms take 3–6 days to develop and include fever, chills, headache, backache, and muscle aches. About 15% of people who get yellow fever develop serious illness that can lead to bleeding, shock, organ failure, and sometimes death.

How can travelers protect themselves?

Get yellow fever vaccine:

After receiving the vaccine, you will receive a signed and stamped International Certificate of Vaccination or Prophylaxis (ICVP, sometimes called the “yellow card”), which you must bring with you on your trip.

For most travelers, one dose of the vaccine lasts for a lifetime. Consult a travel medicine provider to see if additional doses of vaccine may be recommended for you based on specific risk factors.

In rare cases, the yellow fever vaccine can have serious and sometimes fatal side effects. People older than 60 years and people with weakened immune systems might be at higher risk of developing these side effects. Also, there are special concerns for pregnant and nursing women. Talk to your doctor about whether you should get the vaccine.

About Me

I am a pediatrician based at Mohali, a suburb of chandigarh, North India. I have my own virtual office at www.charakclinics.com; I have been a pediatrician since 1994. I hope to make ths blog a regular feature with tonnes of relevant info for parents, especially in India, because i feel that "informed parents are better parents". My interests include research in OPD practice, specifically new vaccines and travel medicine. I am a member of American Academy of Pediatrics, Indian Academy of Pediatrics, and various travel organizations like International Society for Travel Medicine (ISTM), American Society of Tropical Medicine & Hygiene (ASTMH), International Association for Medical Assistance to Travelers (IAMAT), and British & Global Travel Health Association (BGTHA)